ORGANISA TlON MONDIALE DE LA SANTE
Buran rillml •• I, Mi.llarmh arlentll.
Regional Committee for the Eastern Mediterranean Fifty-first Session
Agenda item 10
EMlRC51/8 September 2004 Original: Arabic
Evaluation report of the Joint GovernmentIWHO
Programme Review and Planning Missions in 2003
Contents
1. Introduction ... 1
2. Guiding principles ... 1
3. Objectives ... 3
4. Planning process: steps and tasks ... 3
5. New elements in the JPRM process 2004-2005 ... 4
6. Content and format of workplans ... .4
7. Outcome ... 4
8. Conclusion and recommendations ... 8
1. Introduction
Working in and with countries is the raison-d'etre of the World Health Organization. A large part of the resources of WHO is spent to support directly the Member States in their efforts towards national health development to measure health outcomes. Achieving results at country level represents a continuous challenge to WHO at different levels to implement activities in such a way that they reflect the priorities and concerns of Member States, and draw on the synergistic strengths of headquarters, and the regional and country offices.
The Joint Programme Review and Planning Mission (JPRM) is a planning and consultative process. It aims at ensuring that the collaborative programmes are in line with the national health policy and will strengthen the national capacity for achieving the health goals and aspirations. During the JPRM, operational plans for the various collaborative programmes are developed listing in detail the expected results to be achieved, the products or services and the activities to be delivered in the biennium. The JPRM document reflects the country's health needs and national programme priorities. It expresses a mutual agreement between WHO and the Government on the priority areas of the cooperation and the expected results of collaborative programmes.
In past planning cycles there has been a weak link between what is actually described in the strategic programme budget and what is finally planned in operational terms. Emphasis during the JPRM cycle for 2004-2005 conducted in 2003 was placed on re-establishing a logical link between these steps. Making explicit how programme delivery relates to the short-term and medium- term objectives of the cooperation, and how it contributes to global and regional commitments was a major requirement. The global and regional documents on Health for All in the 21st century and the 10th General Programme of Work for the period 2002-2005 provided the policy framework of WHO. The global strategic directions and core functions of WHO were derived from these documents.
The global and regional priorities defined in the programme budget 2004-2005 and in resolution EM/RC48/R.5, respectively, provided guidance to the teams who participated in the JPRM in all countries of the Region. In addition, the regional programme budget 2004-2005 spelled out the regional strategic directions and programme issues and challenges that Member States and the WHO secretariat are expected to address through the process of operationalization that the JPRM is designed for.
In all JPRMs, the teams followed clear guidelines which were distributed to them prior to the missions and which helped the teams in priority-setting, reporting and the use of standard terms. These guidelines included the guiding principles for programme planning, the objectives of the JPRM, strategic and operational planning requirements, the steps of the planning process, the mandatory data to be provided in work plans, the planning tools and instruments and several annexes.
2. Guiding principles
The following guiding principles were set for conduct of the JPRMs for 2004-2005.
1. Mutually agreed priorities and expected results for medium-term and short-term cooperation are defined in order to focus the collaborative programmes.
2. Technical cooperation reflects WHO's contribution to the national health development process (no WHO programmes, but country programmes supported by WHO).
3. Country needs and priorities are the starting points of JPRM workplan development, with reference to regional and global priorities.
4. WHO's secretariat and Member States will monitor and assess the performance of collaborative programmes based on evidence of the achievements.
5. Performance indicators will be defined for country programme objectives and expected results to enable a judgement to be made on the level of the achievement.
6. WHO's budget should be used primarily and increasingly for agreed priorities.
7. Workplans incorporate both regular budget and other sources, whenever the latter is available.
8. The responsibilities and inputs from the Member State and WHO's secretariat in support of the collaborative programmes will be agreed upon at the time of developing the workplan.
9. Plans for monitoring and evaluation of collaborative programmes will be prepared as an integral part of the JPRM process.
10. The planning tool (Workplan Editor) and the Regional Activity Management System (RAMS) are the management tools for planning, monitoring and reporting of the workplans.
Focusing on the links between strategic planning and operational planning, the teams were well equipped through briefing and training on these subjects. Guidelines were provided to serve that purpose (see Table 1). The attention of the tearns was drawn to the need to state explicitly what a collaborative programme with a particular country intends to achieve strategically over a 4-6 year period and operationally over a 2 year period. Priority areas for cooperation and related country objectives were outlined. The country-level objectives reflect a medium-term change to which the WHO's secretariat as a whole is committed. The expected results were defined in the specific context of the country while expressing a contribution to the Organization-wide expected results stated in the programme budget. They reflect the commitment and the responsibility of the country office to achieve in that particular country.
Table 1. Comparison between strategic and operation planning
Objectives 01 JPRM
To review collaborative programme in the context of national health and regional health for all policies
To agree on priorities for cooperation and expectad response by WHO·s secretariat
To plan the collaborative programme
Strategic planning Outcomes
Lessons learned (medium-term perspective)
Focus
• Priority areas
• Objectives (madium·tenn period) Reference
• Mid-term review (current biennium)
• Programme budget evaluation (previous biennium)
• Country evaluation Priority areas for collaborative programme (for next medium-term period, or adjustment for current period)
Scope and range 01 WHO's response (core functions for next medium·tenn period or adjusbnent for current period)
Strategic planning (next 4 or 6 years)
Planning elements
• Objective (per priority area)
OperaUonal planning Outcomes
• Lessons leamed (for short·tenn operations)
Focus
• Country expected results
• Products and services
• Activities
• Resources Reference 1
• Mid·tenn review (current biennium)
• Programme budget evaluation (previous biennium)
Country expected results
• For the next 2 years
• Per priority area
• Linked to medium·tenn objectives
Operational planning (next 2 years) Planning elements
• Products and services (per country expected result)
• Related activities (per product or service)
• Workplan budgets
1 For details see Monitoring, evaluation and reporting. Guidance for 2002-2003, Geneva, WHO, 2002 (WHO/PMEl02.5).
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3. Objectives
The JPRM is a collaborative process that involves the WHO's secretariat and the Government. It aims to ensure that the collaborative programmes are in line with the national health policy and will strengthen the national capacity for achieving the health goals and aspirations. The process in particular enables WHO and the Member States to:
• review the implementation. adequacy and efficiency of WHO collaborative programmes in the context of national health and regional health for all policies;
• assess the progress achieved;
• identify problems and propose solutions;
• agree on priorities for cooperation and expected response by WHO's secretariat;
• undertake detailed programme budgeting and prepare plans of action for collaborative programmes;
• develop and outline the strategic directions for the future biennium.
4. Planning process: steps and tasks
The following four main steps were followed during the planning process of the JPRMs 2004-2005.
1. Preparation and initial planning
The preparation steps included several activities implemented at regional as well as country levels. All Regional Advisers in the Regional Office were involved in assisting WHO Representatives to prepare the programme profiles. to identify and suggest typical products or services for their technical areas that could be considered and to elaborate specific briefing notes for each country.
At country level. WHO Representatives took the lead in working closely with the national authorities to identify the national team members and to prepare. jointly with them. the country and programme profiles. This included identifying. tentatively. the country priorities. the type of response expected from WHO's secretariat. the country expected results and products/services. taking into consideration the proposals and suggestions made by the Regional Advisers in their specific briefing notes. Each WHO Representative andlor the national focal point prepared a country note on ongoing coordination with other United Nations agencies and bilateral donors. He/she also briefed representatives of other health-related sectors. relevant United Nations agencies and nongovernmental organizations and arranged for the team to meet them during the JPRM process.
2. Country missions
The joint Ministry of Health and WHO teams reviewed the programmes. met with concerned partners.
consulted the national programme managers. and went through the detailed process of planning to produce the draft JPRM reports.
3. Consultation and finalization of the plans
The draft reports went through a consultative process in which Regional Office staff. the WHO Representatives and national authorities were involved. The purpose of this step was to ensure the consistency of these reports with WHO policy and to receive feedback.
4. Scrutiny and approval of plans
Before submission of the reports to the Regional Director for approval. the workplans were reviewed to assess adequacy of planning and the completeness of data. All approved reports were sent to the Ministers of Health in Member States for their signatures. By the end of February 2004. almost all JPRM reports were signed and hence constituted the formal agreement between WHO and the respective country in the current biennium.
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5. New elements in the JPRM process 2004-2005
• The name of the process was slightly modified to "Joint Programme Review and Planning Mission" instead of "Joint Programme Review Mission" but the abbreviation (JPRM) remained unchanged.
• More time was allowed than previously for preparation at country as well as at regional level.
Detailed plans of all steps were prepared and implemented.
• Consistency was maintained with the Organization-wide operational planning guidance for 2004- 2005 (WHOIPMEl02.06).
• The process was based more intensively on a results-based management approach.
• More emphasis was given to the strategic planning component of the JPRM which was linked to the Country Cooperation Strategy (CCS) in countries where that had been finalized.
• The indicators for expected results at regional and country levels were dealt with more seriously.
The type of each indicator, its base at the beginning of the biennium and its target at the end of the biennium were identified. Evaluation will be made on the basis of these indicators.
• All available regular budget allocations and all required funds from other sources were planned.
The outcome of the JPRM 2004-2005 therefore represents a comprehensive one-country plan and one-country budget.
• Some new terms were used based on the agreed-upon Organization-wide glossary of terms.
• The Organization-wide guidance for monitoring, evaluation and reporting (WHOIPMEl02.5) was adhered to.
• Some modifications in the Workplan Editor and hence in the Regional Activity Management System (RAMS) were made in order to respond to the changes.
6. Content and format of workplans
The overall content and format of 2004-2005 JPRM documents were slightly modified. In the narrative section, under the heading "Issues and challenges", each programme of cooperation establishes the basis and provides the rationale/justification for the national expected results to be achieved at the end of the biennium. The tabular section of the Workplan Editor lays down, in a hierarchical order, the expected results, products, activities and activity components. The activity codes, time lines, budget allocation and financial flows are plotted alongside each of the hierarchical components of the country plan.
Regarding the format of the workplans, the use of quarters (Qs) for the time of implementation was changed to indicate the month in which the activity is supposed to be implemented. The planned budget comprises the available budget from regular resources plus what is required from other sources.
The name of national officers in charge of the expected results are included in the workplans. The indicators for each expected result are listed at the end of the workplan with their baselines and targets.
7. Outcome
The overall process of the JPRMs took about one year, starting in April 2003 and ending in March 2004, with the exception of Iraq which was finalized in May 2004. Sixteen missions were fielded to 16 Member States in which the JPRM was undertaken. Officials from six countries were invited to the Regional Office.
Table 2 gives the distribution of numbers of workplans, expected results, products and budget by country. It shows that approximately 400 workplans were prepared in all countries of the Region for the biennium 2004-2005. These plans include 1200 expected results and approximately 1900 products. More than US$ 50 million from the regular budget and more than US$ 153.5 million from expected other sources were planned to meet the requirement to implement these plans.
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Table 2. Distribution of workplans, expected results, products and planned budget by country, JPRM 2004-2005
Country No. of No. of No. of Allocated Planned
workplans expected results products regular other sources budget
Afghanistan 15 84 142 5316000 22323002
Bahrain 15 54 75 342000 736775
Djibouti 21 41 66 1760000 4040 542
Egypt 25 66 94 3123000 4154870
Iran. Islamic Republic of 38 90 127 3010000 15596 710
Iraq 6 10 42 2605000 37057152
Jordan 36 65 72 1390 000 1033069
KuwaH 13 22 24 149900 33000
Lebanon 27 75 126 1370000 1524045
Libyan Arab Jamahiriya 5 33 48 925000 1036020
Morocco 18 34 65 2835000 2109000
Oman 28 60 101 1068000 442854
Pakistan 29 88 157 5367000 20295492
Palestine 12 19 25 998000 188000
Qatar 10 12 96000 0
Saudi Arabia 13 55 61 1407000 846658
Somalia 26 64 107 4535000 25858960
Sudan 21 117 264 5581000 13158 941
Syrian Arab Reptblic 10 77 83 2015000 1545 8BO
Tunisia 26 65 78 1527000 125 874
United Arab Emirates 5 25 26 100 900 29000
Yemen 11 76 108 4658000 1565 599
Total 401 1232 1903 50378800 153499243
Figure 1 shows a comparison of the number of workplans, expected results and products in the current biennium with the previous three biennia in Member States. The trend in reduction in the number of all of them can be clearly seen, indicating adherence to the policy of placing more focus on areas with higher priority.
3500
3000
2500
.8
E 2000•
Z
1500
1000
500
~
... ~
~ "
-...
---
199811999 200012001 200212003 2004/2005
Biennium
Figure 1. Comparison between numbers of workplans, expected results and products in the last four biennia
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-'-Workplans
~ Expected results ... Products
No. 01 Planned regular budget % Planned other sources % TOTAl %
Regional priorities expected ROnCp Country Total ROnCp Country Total other
(according to resolution EMJRC481R.5) results regular lources
budget
1 Development of hUman resources for health, including capacity- 230 490 050 8023030 8513080 10.3 3505590 42080553 45 586143 19.7 54 099223 17.3 building in fonnulating evidence-based health policies,
strengthening of health i"fonnatlon and dissemination. strategic planning, monitoring and evaluation
2 Poverty reduction and better health through the basic 55 11300 3200 100 3211400 3.9 414500 2336 929 2751 429 1.2 5962829 1.9
development needs approach healthy villages, heatthy cities, self- reliance at family level and home health care
3 Control of communicable diseases of regional importance. with 378 858 250 7090 817 7947067 9.7 52302168 76443924 128746 092 55.7 136 693159 43.6 focus on blood safety as well as eradication, enmination and
control of diseases, particularly poliomyelitis, measles. neonatal tetanus, tuberculosis malaria, other tropical diseases, HIVIAID
4 Creating healthy communities and promoting healthy lifestyles, 213 238639 2415065 2653 704 3.2 1 823454 3083161 4706 615 2.0 7360319 2.3 including the Tobacco-Free Initiative, promotion of health of the
elderly and nutrition
5 Non-communicable disease prevention and control (cancer, 130 65000 1761400 1 826400 2.2 662670 3413 n3 4076443 1.8 5902843 1.9
cardiovascular diseases, diabetes, mental health and substance abuse)
6 Maternal and child heaHh 86 123500 2255100 2378600 2.9 1 710904 8559580 10270484 4.4 12649084 4.0
7 Access to, and rational use of, affordable essential medicines an 66 162000 932200 1094 200 1.3 681000 613573 1294 573 0.6 2388n3 0.8 vaccines
8 Development of health systems and services 116 60000 7178018 7238 018 8.8 755000 5389341 6144 341 2.7 13362359 4.3
9 Promotion of technology transfer, health information support and 60 3670679 663500 4334179 5.3 4990 321 641093 5631414 2.4 9965593 3.2
capacity~building in health research
10 Environmental health, with particular emphasis on environmental 87 777 000 1090 300 1867300 2.3 1346 518 2566 595 3913113 1.7 5780413 1.8 assessment and environmental epidemiology, and water safety,
securitv and sanitation
0 WHO presence In countries 12026000 12026000 14.6 800000 2600 000 3400000 1.4 15426000 4.9
1 Intercountry programmes, staff costs and operational costs at the
102 23069582 23069582 28.0 23069582 7.4
h R~ional Office
e Others (Emergency preparedness and humanitarian action, 2249000 3940 470 6189470 7.5 6422882 8004 660 14427742 6.3 20617212 6.6
r WHO's presence in countries, External coordination & resource mObilization, Programme planning, monitoring and evaluation,
s Budget and finance, General administration)
TOTAL 1523 31 n3000 50576 000 82349000 100 75215007 155 733382 230948 389 100 313297389 100
RD: Regional Office lep: Inlercounlry programme
With regard to planning by area of work, Table 3 shows the distribution of resources by the lO regional priorities approved by the Regional Committee in resolution EMlRC4B.R.5. It can be noted that BI.I % of the total funds were allocated to those regional priorities. Approximately 44% of funds were allocated to the area of control of communicable diseases, including vaccination programmes and poliomyelitis eradication. During the same biennium, 17.3% of funds were planned for the area of human resources development for health including capacity-building in formulating evidence-based health policies, strengthening of health information and strategic planning, monitoring and evaluation.
The remaining funds were planned between the remaining regional priority areas. (See Figure 2.) With regard to planning by activity component, approximately one-third of the regular budget at country level was allocated for the development of national capacities in a form of either local or external training. This is one of the most important priority areas as identified by most of the Member States in the Region. A quarter of the regular budget was allocated to technical support to cover contractual agreements at country level, 16% to cover the local cost of supervision, monitoring and field work, and 11 % for logistical support, including basic supplies and equipment and health and learning materials. The remaining 15% was allocated for other activities such as long-term staff, emergencies and miscellaneous.
Analysis of the regional versus country allocations in Table 4 shows that 71 % of the total budget was allocated to country programmes while 29% was allocated at regional level. Table 5 summarizes the distribution of resources by major priority area.
WHO presence in countries
4.9%
Communlty- based initiatives
and poverty reduction
1.9%
Health promotion 2.3%
Maternal and child health
4%
All other areas 21.7%
Human resources development
17.3%
Communicable diseases
43.6%
Figure 2. Distribution of resources by major priority area, JPRM 2004-2005 (aU sources)
Table 4. Distribution of resources by level (regional and country), 2004-2005
Level Regular budget % Other sources % Total %
Regional 31773000 39 52500 000 26 84273000 29
Country 50576000 61 149500000 74 200076000 71
Total 82349000 100 202000000 100 284 349 000 100
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Table 5. Distribution of resources by major priority area, 2004-2005
Major priority area Regular budget Other sources AU sources
(%) (%) %
Communicable diseases 9.7 55.7 43.6
Human resources development 10.3 19.7 17.3
Health system and services development 8.8 2.7 4.3
Maternal and child health 2.9 4.4 4.0
Health promotion 3.2 2.0 2.3
Community-based initiatives and poverty reduction 3.9 1.2 1.9
WHO presence in countries 14.6 1.4 4.9
All other areas 46.6 12.9 21.7
The issue of sustainability was given high attention during the JPRM exercise. The history, present status and future of all national programmes supported by WHO were discussed and reviewed thoroughly. Recommendations to overcome difficulties and obstacles facing these programmes have been proposed to national authorities.
8. Conclusion and recommendations
The JPRM has proved to be a very valuable process in the past 22 years. The experience in this regard in the Region has become very rich. It is a lively process whereby continuous improvement has taken place every biennium. Member States have become familiar with it and a large number of nationals are increasingly making use of the tools used in the planning as well as monitoring of their national programmes.
The use of the Regional Activity Management System (RAMS) tool has been expanded over the years to cover the financial and technical monitoring and evaluation purposes needed at country and regional levels. A lot of improvement was achieved in the 2004-2005 JPRM due to the increased number of staff trained on the results-based management approach. More emphasis was placed on identification of appropriate indicators to measure the progress made in the implementation of the expected results.
Most of the workplans include indicators with their baseline and targets. This will facilitate the process of monitoring, reporting and evaluation during the biennium.
It has been clearly noted that timely preparation and early involvement of the national partners resulted in improved sharing of information, good participation and joint planning. The steady improvement in priority-setting and planning skills were evident. More focus on the most important priorities was achieved. However, there are still some difficulties in the appropriate formulation of expected results and performance indicators.
The one-country plan and one-country budget theme was translated into action by planning all available resources as well as expected other sources for the whole biennium. This is expected to facilitate the utilization and then reporting on the use of extrabudgetary resources that could be made available during the biennium.
The following recommendations are made for the next round of JPRMs 2006-2007:
I. greater involvement of nationals from different health-related sectors as well as other partners at country level;
2. more training for nationals involved in JPRMs on results-based management;
3. early submission of briefing material by Regional Advisers to their counterparts together with more dialogue with them to reach common understanding and sound agreement on issues, challenges and action to be taken under the different priorities;
4. more training of staff on the different functions and use of RAMS and associated tools.
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